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Based on observation and interview the facility failed to maintain a proper plumbing installation to prevent the potential of back siphonage of contaminated water into the supply water consumed by patients resulting in the potential for patient harm to all patients served by the facility.

On 12/13/2016 at approximately 1100 during the facility tour with the Building Director, it was noted that the bed pan washer hoses, serving the clinical sinks in the soiled utility rooms located on the second and third floors of 1971 Building, were equipped with hand control valves downstream from atmospheric vacuum breakers. No shut-off valve shall be located downstream from an atmospheric vacuum breaker. This was confirmed with the Building Director at the time of observation.

Based upon observation and interview the facility failed to provide and maintain adequate physical facilities for the safety and needs of the patients and was found not in substantial compliance with the requirements for participation in Medicare and/or Medicaid at 42 CFR Subpart 483.70(a), Life Safety from Fire, and the 2012 edition of the National Fire Protection Association (NFPA) 101, Life Safety Code (LSC), Chapter 19 Existing Health Care. Findings include

See the individually and below cited K-tags dated December 14, 2016.
K-0321
K-0363
K-0753
K-0911
K-0920
K-0923